This questionnaire is designed to capture your local information on flooding in your area.

Having viewed the draft flood maps we would ask you to fill out the questions below to inform and enhance the accuracy of the flood maps.

We would like to thank you for taking the time to answer this questionnaire.

Q1. Have you experienced flooding in the past?Please tick.

Yes / No / Unsure

Q2. If Yes to the above, where did this occur? Please give location/address.

Q3. Was this: Home, Business or Other? Please tick.

Home / Business / Other

Q4. When did this happen? – Please give Year & month.

Year / Month

Q5. Was this a once off or did it occur on several occasions? Please specify:

Q6. Please describe the damage involved.

Q7. Is this flood event represented on the draft flood maps?

Yes / No

Q8. Please provide any comments you may have on the draft flood maps.

Information and comments such as areas you know have flooded but which are not included on the map can be valuable at this stage to help ensure the accuracy of the flood maps.

In providing your comments, please name, as clearly as you can, the location (street / town / house number) you are referring to. By clearly identifying the location we will be able to find the place on the map that your comments are in relation to.

Q9. Please indicate how important you feel the following objectives are when considering flood risk management options?

Please tick on a scale of ‘Very Unimportant’ to ‘Very Important’.

Issue / Risk To / Very Unimportant / Unimportant / Neither Important nor Unimportant / Important / Very Important
Local economy /  /  /  /  / 
Environment /  /  /  /  / 
Transport (road / rail) /  /  /  /  / 
Utilities (electric / gas / water) /  /  /  /  / 
Habitats / species /  /  /  /  / 
Agriculture /  /  /  /  / 
Visual amenity /  /  /  /  / 
Vulnerable people /  /  /  /  / 
Vulnerable buildings /  /  /  /  / 
Other (please specify)
______/  /  /  /  / 

Q10. Are there any local features / important places you feel are important to bear in mind when considering flood risk management options?Please provide details below.

To help us make sure that we have contacted a fair representation of the population, it would be helpful if you could provide the following information:

Q11. Age.Please Tick.

16-24 / 25-34 / 35-44
45-54 / 55-64 / 65+
Prefer not to say

Q12. Gender. Please Tick.

Male / Female / Prefer not to say

Q13. How did you hear about this event?Please tick all that apply.

Website / Newspaper / Radio
Word of mouth / Local Authority / Other (please specify below)
If other please specify:

Q14. Contact Details

Postal address
Name:
Address1:
Address2:
Address 3:

Email address

Your Email address:

Would you like to be kept informed of progress via our newsletter (which is released every four months)?

Yes / No / If Yes, please give details below:

If Yes to the above, how would you like to be contacted: Please tick as appropriate.

Email address / Postal Address

Please return the completed questionnaires to any member of our team.

Alternatively, questionnaires can be returned using the postal or email addresses shown below.